Rationale: The management of women with epilepsy (WWE) poses many challenges for physicians. The primary goal in the treatment of epilepsy during pregnancy is to achieve the best possible control of seizures with the least adverse effects associated with exposure to antiepileptic drugs (AEDs). The guidelines for managing WWE who are pregnant are expanding but the treatment of status epilepticus in women who are pregnant are still unclear. Additionally, much of our data comes from the effect of generalized seizures on the fetus with little on focal seizures and even less on focal status epilepticus. Methods: Here, we present two case reports of pregnant women with poor pre-pregnancy seizure control that presented in focal SE secondary to medication non-compliance. Both cases provide data from video EEG monitoring and fetal heart tracing recorded simultaneously. Results: Case 1: 29-year-old right-handed female G1P0 with diagnosis of right temporal lobe epilepsy (since age nine). Patient was admitted for increased seizures frequency due to medical non compliance. Several clinical and subclinical frequent seizures were recorded. EEG onset was seen over the right centro-parietal area with spread to the right posterior temporal area, consistent with focal SE. FHT was reported daily as appropriate for gestational age with moderate variability, no accelerations or decelerations. Two-hour neonatal stress tests (NSTs) were continued by obstetrics with no changes being noted during her seizures both clinical and subclinical, and AED IV loading. Maternal autonomic stability was retained and eventually seizures stopped after restarting her home AEDs. She was discharged and later gave birth to a viable baby at 39 weeks. Case 2: 26-year-old female G3P1011 with a history of developmental delay, colpocephaly and pachygyria vs. ectopic gray matter in the bilateral occipital horns and a history of multifocal epilepsy (since age 11). During this pregnancy patient had three hospital admissions for focal SE with multifocal origins (right fronto-central, right posterior, and left posterior quadrant). All hospital admission were the consequence of medication non compliance. Both subclinical and clinical events were captured on VEEG. During her third admission (27 weeks) VEEG data was recorded simultaneously with FHT. Initially FHT was reassuring with baseline 140s, moderate variability, occasional accelerations, and no decelerations during all of her seizures. After the addition of phenobarbital and propofol, FHT demonstrated absent/minimal variability along with maternal heart rate decrease from 90s to 60s with relative hypotension. She was sent for an emergency C-section at 28 weeks leading to the cessation of her seizures. The baby’s birth weight was 1,070 grams with no obvious deformities. Conclusions: Both cases provide evidence that with the retention of maternal autonomic stability and reassuring FHT, focal seizures and focal status epilepticus may not be causing immediate harm to the fetus. Case 1, the mother retained autonomic stability throughout her hospital admission with concomitant stable FHT. She was discharged and her future delivery was uncomplicated at 39 weeks. For case 2, it wasn't until the escalation of therapy with phenobarbital and propofol did the mothers baseline HR decrease as well as developing relative hypotension. This directly led to concerning findings on FHT. Future research focusing on FHT during status epilepticus may show monitoring FHT and maternal vital signs to be important elements in determining how aggressive to treat WWE. Funding: Please list any funding that was received in support of this abstract.: None.
